Provider Demographics
NPI:1457823171
Name:CHOUINARD, DONNY JOE
Entity Type:Individual
Prefix:
First Name:DONNY
Middle Name:JOE
Last Name:CHOUINARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 BLACK RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2416
Mailing Address - Country:US
Mailing Address - Phone:315-782-1777
Mailing Address - Fax:
Practice Address - Street 1:482 BLACK RIVER PKWY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2416
Practice Address - Country:US
Practice Address - Phone:315-782-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator